Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01915 | Date 11/04/2019 |
| Token No | SM/18-19/3189 11/04/2019 | Serial | 011 |
| Patient Name | Miss KRISHNA DAS | Contact No | 8981218370 |
| Address | 573 G.T.ROAD | Age | 14 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||